TBI and Identity Loss:
Recovering Self
Ron Broughton, LPC, CBIST ·
Chief Clinical Officer ·
Brookhaven Hospital
Disclosure Statement
My only disclosure is that I am an employee of
Brookhaven Hospital in Tulsa, Oklahoma. The
content of this presentation is designed to
promote quality improvements in healthcare and
not advocate for any particular provider or entity.
In addition, every effort has been made for the
information to well balanced, evidence based and
unbiased.
Overview
1.
Developed from psychotherapy perspective.
2.
Concepts generalize to other professions (e.g., OT, SL, PT).
3.
Challenges all to work toward optimal outcomes.
“I knew my “self” and my role in life had changed
and I would have to accept it and adapt.”
Today’s Goals
LEARN
About identity change after traumatic or
acquired brain injury.
Today’s Goals
REVIEW
Seminal research on concepts
related to identity loss
Today’s Goals
LEARN
Three models of disability identity
after brain injury
Today’s Goals
UNDERSTAND
Difference between an adjusted vs.
a self-examined life post injury
Today’s Goals
LEARN
How to find personal meaning
in life after brain injury
Identity: persons’ conception and
expression of their individuality
or group affiliation
Self-concept: the sum of a being’s
knowledge and understanding of
self.
Sarah’s Storm
The Car
Wreck
The
Symptoms
Depressed
Anxious
Lack of Concentration
Unable to Work
Relationships
Suffer
Work
Suffers
Sleep
Suffers
Divorce
Diagnosis
WHAT ARE THE
DAMAGED BRANCHES?
Ambiguity
&
Uncertainty
DAMAGED BRANCHES
Blurred
Boundaries
DAMAGED BRANCHES
Stranger
in
Relationships
DAMAGED BRANCHES
TBI Creates
Uncertainty
and Stress
DAMAGED BRANCHES
Walking
on
Eggshells
DAMAGED BRANCHES
Identity
Loss
DAMAGED BRANCHES
What About
Identity Loss?
Loss of
Self
Long-term physical,
cognitive and emotional
problems accompany
brain injury
Ambiguous loss is most
stressful & defies closure
Self uncertainty correlates with
perceptions of boundary
uncertainty with others
Manifests as
identity uncertainty
Client may develop a
profound “loss of self”
Three Categories of Loss
(Nochi, 1998)
Loss of clear self-knowledge
•
•
•
•
Memory loss effects
Lack understanding of reason for situation
Uncertainty of where “I” come from
Terrified of all the blanks
“I struggle daily to do my job and be the person I used to be. I
still, after two years, am trying to redefine myself. I don’t know
this person anymore. She is not reliable and cannot be trusted as
my best friend.” --Alienation from self
Three Categories of Loss
(Nochi, 1998)
Loss of self by comparison
•
•
•
•
Usually compare with pre-injury self
Compare self with what they are AND
What they would have been-The loss of INDIVIDUAL POTENTIAL
“After the accident…my son was three years old, and I knew he
was my son. But the feeling like we were connected was gone.
He was a total stand alone person. I’d always felt like we were
somehow, like there was a magic chord from me to him. It was
gone right after the accident.”
Three Categories of Loss
(Nochi, 1998)
Loss of self in the eyes of others
• Believe others think less of them
• Others put a negative level on them
• Individuality is obscured by labels
“I don’t like the term TBI because it just puts another stigma. It
puts things on people. Suppose I say I have a TBI, and that’s
going to stop people from getting to know me.”
“Imagine waking up each day with a
pounding headache, always feeling like you
have a hangover plus a bad flu after being
up three nights in a row; having trouble
concentrating, remembering, and getting
your thoughts together; losing your temper
and snapping at people for no reason. On
top of that, nobody believes you or thinks
you are crazy.”
Dunn, D. & Burcaw, S. (2013). Disability
identity: Exploring Narrative Accounts of
Disability.
Examined writings of those with disability to
identify illustrations of their disability identity.
Dunn, D. & Burcaw, S. (2013)
Disability Identity can focus on:
Past: what once was.
Present: what is still true.
Future: our wishes, expectations and fears.
Dunn, D. & Burcaw, S. (2013)
Consider Disability Identity on a Continuum
Disability identity may or may not be activated.
By definition, professional services activate the identity.
Dunn, D. & Burcaw, S. (2013)
Three Categories on the Continuum
1. Individual with some functional limitations &
may identify self as disabled or not.
2. Disability rights activists focus on social
constructs and civil rights.
3. Disabled identity is tied to self-concept…
a) Positive
b) Negative
c) Ambivalent
Dunn, D. & Burcaw, S. (2013)
Negative and Ambivalent Consist of Two Groups
Coping
Succumbing
• Emphasize assets vs.
fixing what’s broken
• Focus on skills
• Set goals
• Mask disability
• Seek impossible standards
• Emphasize deficits
Creating Self
Dunn, D. & Burcaw, S. (2013)
One Key
Finding Personal Meaning Post Injury
•
•
•
•
Significance in Life
Goal Setting
Engaging in Sense Making
Finding Benefits Associated with
Injury
Dunn, D. & Burcaw, S. (2013)
Significance in Life
Goal Setting
Engaging in Sense Making
Finding Benefits Associated with Injury
Important Aspects of Identity and
Becomes a Form of Acceptance
What About
other
Research?
“Am Not Was”
Dewar & Gracey (2007)
Case study of symptoms
of identity loss of person
suffering from herpes
simplex encephalitis.
“Am Not Was”
Dewar & Gracey (2007)
The Symptoms
• Anxious
• Loss of Interest
• Hopelessness
about Future
• Unable to Work
• Limitations in
Fulfilling Role
• Decreased Social
Contact
• Fear of Not
Recognizing
Others
“Am Not Was”
Dewar & Gracey (2007)
Her Identity
“If I can’t remember my friends, then
I am a bad, uncaring person.
“If I don’t do things for my children,
then I’m a bad mother.”
“Am Not Was”
Dewar & Gracey (2007)
What Are the
Trigger Situations?
• Failing to Recognize Someone
Prosopagnosia
• Others Doing Things for Her
• Family Not Getting Along
• Family Efforts to Reassure
• Family Taking on Tasks
“Am Not Was”
Dewar & Gracey (2007)
Interventions
Standard CBT
•
•
•
•
•
Rapport building
Self-monitoring
Identify negative thoughts
Breathing techniques
Decrease anxiety
“Am Not Was”
Dewar & Gracey (2007)
Interventions
Behavioral Experiments
•
•
•
•
•
Positive experiential learning
Complete 75% of role tasks
Relearn autobiographical memory
Face recognition
Shared understanding with family
to not threaten identity
“Am Not Was”
Dewar & Gracey (2007)
Outcomes
Increase in Self-ratings
of
Pre-injury vs. Current Self
Increase in Self-esteem
How we
create a new
realistic
outlook?
Disordered Mind, Wounded
Soul: The Emerging Role of
Psychotherapy in
Rehabilitation After Brain
Injury
Prigatano, G. (1991)
The Premise
C.G. Jung: “The soul of man seeks Meaning or
Purpose for its existence.”
Prigatano, G. (1991)
The Premises
1. In life transitions, people wonder about the meaning of
their life.
2. Brain injury produces an abrupt transition in life.
3. Individuals ask, “Will I be normal,” Why did this happen
to me?” “Is life worth living after brain injury?”
4. Traditional psychotherapy (or others) cannot answer
these.
5. They are existential and only by entering the
experience of the patient are the questions
answerable.
6. Thus, rehabilitation and psychotherapy must focus on
the disordered mind and wounded soul.
Prigatano, G. (1991)
Understanding the Patient
Unfortunately we understand the patient in
relation to diagnoses, behavior and billing codes.
“Understand the mind of the patient and
rehabilitation goes more smoothly.”
Prigatano, G. (1991)
Understanding the Patient
•
•
•
•
Understanding of patient reluctance
Strike balance with the Medical Model
“Get in to” the patient’s world
Facilitate engagement in the
rehabilitation process
• Juxtaposed to our “silo services” method
• Applicable to all disciplines
Prigatano, G. (1991)
Focus on the Soul
Therapy is a process of “teaching
the patient to learn to behave in
his/her own best self-interest.”
Focus on “discovering the
meaning of their lives in the face
of, not despite, the brain injury.”
Prigatano, G. (1991)
Psycho (and other) therapy
After Brain Injury
Help the Patient To:
• Understand the impact of brain injury and
commitments they can still make.
• Know the impaired self-awareness interaction of the
injury damage and the premorbid self.
• Guide, not force, to make decisions in their own best
interest…Autonomy.
• Do not overwhelm with information (defined by
diagnoses and billing codes).
• Focus on restoring the shattered sense of identity.
Prigatano, G. (1991)
Prigatano (1991) asserts:
Three symbols in our culture that
“promise” meaning in our life:
• Intelligence
• Beauty
• Winning is Everything
Prigatano (1991) asserts:
Juxtaposed to other symbols that
actually generate meaning:
• Work
• Love
• Play
Therefore, access music, humor, art,
literature, exercise, spirituality and
INDIVIDUAL STORIES or NARRATIVES as
a part of the therapeutic process.
The Challenge
How do we incorporate these
concepts in our service provision?
Where do we start?
The Therapist’s Role
Provide
patience,
sensitivity,
and
objectivity as
the
foundation
Client’s
perceptions
of the deficits
Work toward
better selfobservation
Use realityfocused
methods to
address lack of
awareness rather
than direct
confrontation
Anticipate feelings of
frustration, being
overwhelmed, family
difficulty and
withdrawal from
interpersonal
relationships
Emotional reactions
such as depression,
anxiety, flat affect,
apathy, heightened
emotions and even
chemical dependency
issues
Engage the client
and family as
active participants
Encourage to
resume normal
activities and
assist in restoring
the client’s
diminished power
Therapist frustration
as our own
expectations of
recovery are not
realized
Awareness of
and sensitive to
counter
transference
issues from self
Ben-Yishay & Daniels-Zide (2000).
Examined lives: Outcomes after
holistic rehabilitation.
Poses the question:
“Does attainment of optimal outcomes
following neurorehabilitation require that
the individual achieve an “examined self?”
Ben-Yishay & Daniels-Zide (2000).
Why is “examined self” important?
“To feel healthy again, assist in regaining
(New) individual personality components so
the person can accept voluntarily the
limitations the brain injury imposes”…AND…
“Assist the individual to value their
rehabilitation achievements and view their
present life as meaningful.”
Ben-Yishay & Daniels-Zide (2000).
Ego Identity Components
(Evolving aspects of personhood, Erickson, 1950)
1. Identity as imitation
2. Identity as a sense of continuity
3. Identity as self-definition
Ben-Yishay & Daniels-Zide (2000).
Wellness Components
1. Autonomy
2. Environmental Mastery
3. Personal Growth
4. Positive Relationships
5. Purpose in Life
6. Self-acceptance
Ben-Yishay & Daniels-Zide (2000).
Rating Schema of Acceptance
1. Cessation of “mourning” or agitation over incurred
losses—speak calmly about injury.
2. Morale—able to maintain cheerful & optimistic
outlook on future.
3. Satisfaction with rehabilitation outcome—
expression of satisfaction with accomplishments.
4. Capacity for enjoyment—enjoying pleasurable
activities & laughter.
5. Restored self-esteem—asserts SE has been
restored.
Ben-Yishay & Daniels-Zide (2000).
Two Groups
Adjusted—those who, after treatment,
responded well to intervention but showed
no signs of re-defining themselves.
Self-examined—those who, after
treatment, reflected upon their “self” and
arrived at a subjectively satisfying selfdefinition.
Ben-Yishay & Daniels-Zide (2000).
“Does optimal outcomes following
neurorehabilitation require that the individual
achieve “examined self”.
YES!
Ben-Yishay & Daniels-Zide (2000).
The Value?
The individual exhibits an increased
sense of new personhood,
maximizes their rehabilitation
potential and overall satisfaction.
Medved, M. & Brockmeier, J. (2008).
Continuity amid chaos: Neurotrama, loss
of memory and sense of self.
Seven adults interviewed who are
experiencing autobiographical memory
impairments were interviewed to see how their
narratives and sense of self had changed after
neurotrauma and how individuals attempt to
regain the lost sense of self.
Medved, M. & Brockmeier, J. (2008).
Types of Narratives
1. Restitution stories indicate illness will not
interfere with previous plans and former selves
will be restored in the future.
2. Chaos narratives have little order and makes it
difficult to reflect on their illness experience.
3. Quest stories in which people claim their illness
has produced a new identity.
Medved, M. & Brockmeier, J. (2008).
Identity Construction is an Ongoing Narrative
Strategies individuals use to create a current self
1. Memory importation—transplanting memories
from before the injury.
2. Memory appropriation—taking another’s
memory as their own.
3. Memory compensation—conversationally
compensating for missing memories.
Help the individual sustain personal narratives
in the absence of autobiographical memory.
Medved, M. & Brockmeier, J. (2008)
“Clinical professionals need a better
understanding of how people make
sense of themselves, especially under
extreme circumstances, before
reaffirming or reconstructing a putatively
damaged “self” in people whom the only
thing we know is that they have a
damaged brain.”
Jumisko, E., Lexell, J. & Soderberg, S. (2005).
The Meaning of Living with TBI in People with
Moderate or Severe Traumatic Brain Injury.
Qualitative study of 12 individual’s narratives.
Jumisko, E., Lexell, J. & Soderberg, S. (2005).
What Did the Narratives Reveal?
1. Insulting and exhausting to be checked
constantly.
2. Afraid of the power authorities had over their lives.
3. Hurt if others don’t believe in their opportunities.
Jumisko, E., Lexell, J. & Soderberg, S. (2005).
What did they search for in a rehabilitation
professional?
• One who listened to them.
• One who respected their goals.
• One who showed an understanding of
their situation.
Jumisko, E., Lexell, J. & Soderberg, S. (2005).
What Did They Describe As
Think positively
Trust one’s
possibilities
Hate to give up
Have a strong will
Have hope
Manage feelings of
shame & dignity
Self Awareness
Self awareness is the capacity to recognize your own
feelings, behaviors and characteristics - to
understand your cognitive, physical and emotional
self. At a basic level, it is simply understanding that
you are a separate entity from others.
In a broader sense, the questions, 'Who am I?,' 'What
do I want?,' 'What do I think?' and 'How do I feel
(physically and emotionally)?' are all questions that
require self awareness to answer.
The Physician’s Story
“How could I continue to live
with a deficient brain? My head
injury had been bearable only
because it was
temporary. Permanent injury
meant I had already lost. My
job, my identity, my life, the
real me.”
Medley, et. al. (2010). Brain Injury Beliefs, Selfawareness and Coping: A Preliminary Cluster
Analytic Study Based Within the Selfregulatory Model.
Study to determine if the Self-regulatory Model can
identify different clusters of subjective beliefs,
coping styles and self-awareness with notion that
understanding the interplay will prove more useful in
rehabilitation…. than addressing the factors in
isolation.
Medley, et. al. (2010) Cluster Analysis
The Premise
Maximizing the therapeutic relationship
requires looking beyond client’s (or
therapist’s) perceptions of injury on day
to day functioning.
Medley, et. al. (2010) Cluster Analysis
Other Factors to Consider
1. Client’s expectations about duration
of symptoms.
2. Client’s perception about how
symptoms might be managed.
3. How client makes sense of and
copes with seemingly bizarre
cognitive changes.
Medley, et. al. (2010) Cluster Analysis
Most Importantly
Considering their interaction might better
inform the clinician of the individual’s
rehabilitation goals.
Medley, et. al. (2010) Cluster Analysis
The Self-Regulatory Model
Posits that clients use multiple sources of information
that converge to inform their beliefs and perceptions of
a health threat (the brain injury) thereby influencing
engagement and outcome.
• Internal: somatic experiences and personality
• External: information from health professionals and
social interactions
Medley, et. al. (2010) Cluster Analysis
The Self-Regulatory Model
The internal and external sources in turn
determine the selection of coping strategies and
influence outcomes such as engagement in
treatment and psychological well-being.
Medley, et. al. (2010) Cluster Analysis
The Self-Regulatory Model
Five Core Dimensions
1. Identity: degree to which symptoms are experienced and
attributed to the condition.
2. Cause: attributions for the condition.
3. Time-line: perceived duration of the condition.
4. Consequences: perceived impact on quality of life.
5. Controllability: beliefs about control and associated problems.
Medley, et. al. (2010) Cluster Analysis
The Illness Perception Questionnaire-Revised
Nine Sub-scales Represent Perceptions
1.
2.
3.
4.
5.
6.
7.
8.
9.
Identity: rate if have experienced symptom
Cause: attributions for the condition.
Time-line: perceived acute or chronic.
Consequences: on quality of life.
Personal Control: beliefs about personal control over the
condition.
Treatment Control: beliefs about personal control and efficacy.
Changeability: unpredictability of symptoms
Coherence: understanding of condition
Emotional Representations: negative/positive
Medley, et. al. (2010) Cluster Analysis
Rehabilitation Engagement—Two Phases
Motivational Phase—beliefs and attitudes
toward rehabilitation generate intention.
Volitional Phase—cognitive and executive
functioning influence degree of active and
sustained participation.
Medley, et. al. (2010) Cluster Analysis
Three Clusters Identified
Low Control/Ambivalent—Characteristics
•
•
•
•
Ambivalent in attempt to preserve identity
Lack coherent understanding of injury
Recognize chronic duration
Reported limited symptoms & issues with quality
of life
• Reduced degree of self-awareness
• Defensive denial (more assault injuries)
• More avoidance coping
Medley, et. al. (2010) Cluster Analysis
Three Clusters Identified
High Optimism—Characteristics
•
•
•
•
•
•
•
Decreased self-awareness
Lower perception of chronicity
Lower perception of consequences
High perceived controllability
More coherent understanding of injury
Less avoidance coping
More problem focused coping
Medley, et. al. (2010) Cluster Analysis
Three Clusters Identified
High Salience—Characteristics
•
•
•
•
•
•
•
Experience & attribute symptoms to condition
Highest level of coping strategies
Recognizes consequence of injury
High perceived personal & treatment control
Greater use of problem focused coping
Greater emotional processing
Higher level of treatment adherence
Medley, et. al. (2010) Cluster Analysis
What Do the Results Have To Do with
Identity Recovery?
Emphasizes the clinical notion that every
discipline would be prudent in striving for
a more coherent understanding of the
person’s “self” rather than staying in our
own “silo”.
Understanding and Treating Loss
of Sense of Self Following Brain
Injury: A Behavior Analytic
Approach.
Myles, S. (2004).
Overview
• Speaks to the loss of a sense of self in
brain injury.
• Provides theoretical constructs related to
denial.
• Offers overview of Relational Frame
Theory.
• Advocates the use of Acceptance and
Commitment Therapy as one avenue to
recovering “self as context.”
Myles, S. (2004)
Relational Frame Theory
• Developed within the field of behavior analysis
• An account of language and cognition
• Consists of ability to derive novel stimulus
relations, without training, among events
• In short, responding to one event in relation to
another (If A then B, conversely, If B then A)
Example: from car wreck, person derives relations between
the event and private experiences e.g., anxiety, fear or
flashbacks
Myles, S. (2004)
Relational Frame Theory
Three Distinct Senses of Self
Available to Us
1. Conceptualized Self—our view of self.
2. Self as an Ongoing Process of Verbal
Knowledge
3. Self as Context
Myles, S. (2004)
Relational Frame Theory
Conceptualized Self
• Network of verbal self-relations that develops from
our experiences
• Means of evaluating, explaining and predicting our
own behavior
• We expect congruence between what we say we
are and social feedback
• If not, we defend or distort our experiences of the
world
Myles, S. (2004)
Relational Frame Theory
Self as Ongoing Process of Verbal Knowing
(Ongoing Self-awareness)
• What a person may verbally know
• Consists of our thoughts, emotions, memories and
private experiences
• In essence, comprises our psychological content
• If unable to discriminate and label, we have
decreased self-awareness
Myles, S. (2004)
Relational Frame Theory
Self as Context
•
•
•
•
•
•
Necessary to report events in coherent manner
Provides a sense of perspective, unique point of view
Place from which the person experiences the world
Is the “I” behind the eyes
Safe place from which to know
Never changes and never lost—locked in?
Myles, S. (2004)
Relational Frame Theory
Conceptualized Self Dominates Self as Context
Brain Injury:
A Crisis of the Conceptualized Self
Loss of sense of self as a verbal (relational) process
“I am not the same person.”
Myles, S. (2004)
Relational Frame Theory
Crisis of the Conceptualized Self
Awareness of inconsistency between pre-injury
concepts and post-injury functioning
Competent
Creative
Hard Worker
Me
Professional
Team Player
Myles, S. (2004)
Relational Frame Theory
Crisis of the Conceptualized Self
Awareness of inconsistency between pre-injury
concepts and post-injury functioning
Incompetent
Uncreative
Lazy
Me
Unprofessional
Not Team
Player Myles, S. (2004)
Relational Frame Theory
Conceptualized Self
Brain Injury
Crisis of Conceptualized
Self
Denial
Myles, S. (2004)
Relational Frame Theory
Denial
Understood as Protection
of the
Conceptualized Self
Myles, S. (2004)
Relational Frame Theory
Denial
Unworkable for Two Reasons
1. Individual turns to avoidance.
2. Efforts to avoid increase emotional distress.
Myles, S. (2004)
Relational Frame Theory
The Workable Alternative—Acceptance
Develop Self as an Ongoing Process of Verbal Knowledge
Develop Acceptance, Not for Its Own Sake
Develop Acceptance
as
It is More Workable Than Avoidance
Myles, S. (2004)
Relational Frame Theory
Acceptance Through Self as Context
• Not based on psychological content—the
conceptualized self.
• Not comprised of emotions, thoughts or
private experiences.
• Is the place from which they are known.
• Make experiential contact—mindfulness.
Myles, S. (2004)
Relational Frame Theory
Acceptance Through Self as Context
•
•
•
•
Individual can know psychological content
Alleviates fear of psychological annihilation
Interact with content in non literal way
Experience content as ongoing verbal
relations vs. “facts”
• RFT is the basis for ACT
Myles, S. (2004)
Acceptance and Commitment Therapy
(ACT)
Treatment Approach for Experiential Avoidance
Guides Client to Contact Self as Context
Facilitates Acceptance
Myles, S. (2004)
Acceptance and Commitment Therapy
Views the core of problems as FEAR
Fusion with your thoughts
Evaluation of experience
Avoidance of your experience
Reason-giving for your behavior
Wikipedia (2014)
Acceptance and Commitment Therapy
Views the core of problems as FEAR
Wikipedia (2014)
Acceptance and Commitment Therapy
The healthy alternative is to ACT
Accept your reactions and be present
Choose a valued direction
Take action
Wikipedia (2014)
Acceptance and Commitment Therapy
Core Principles
1. Cognitive Defusion: Learning methods to reduce tendency
to reify thoughts, images, emotions and memories.
2. Acceptance: Allowing thoughts to come and go without
struggling with them.
3. Contact with the Present Moment: Awareness of the here
and now, experienced with openness, interest and
receptiveness.
4. Observing the Self: Accessing a transcendent sense of self,
a continuity of consciousness which is unchanging.
5. Values: Discovering what is most important to the one’s true
self.
6. Committed Action: Setting goals according to values and
carrying them out responsibly.
Wikipedia, (2014)
Acceptance and Commitment Therapy
Two Methods
1. Metaphors for abstract thinking
 The House and Furniture
 Chessboard
2. Experiential Exercises
 The “Observer” Exercise
Myles, S. (2004)
Acceptance and Commitment Therapy
Example
•
•
•
•
Client experienced intense anxiety post injury
Conceptualized as defense of pre-injury self-concept
Guidance to accept new post-injury self-concept
Allowed for pursuit of key life values—
The New Self and Purpose in Life
Myles, S. (2004)
CLIENT’S VIEW OF INDIVIDUAL THERAPY
“It made me feel normal. I wasn’t crazy, I was brain injured.
My therapist helped me understand that everyone’s healing
process is different. She helped me understand the
importance of not over extending myself. She made me feel
safe.”
A Real Life
Example
60 Minutes January 11, 2015
“Conquering the Impossible”
• Three Veterans Returning from Iraq or
Afghanistan
• IED and Double Amputee with Likely Brain Injury
• They Enter The Heroes Project
• The Seven Summits
• Their Work to Reestablish Their Identity and SelfConcept
Loss of Identity
Loss
of
Self-Concept
“Going through my injury, I lost
myself. Didn’t have a clue
who I was.”
Reaching
the
Summit
“Grrrr..ahhhhh…”
Creating
the
New Identity
Changing
the
Self-Concept
“Something that you can carry
with you the rest of your life and
also helps you put closure on a
period in your life too.”
The New Identity
The New SelfConcept
“This injury like does not define my
life, I define it. And life is still able
to be powerfully lived even in this
condition.”
TBI and Identity Loss:
Recovering Self
Thank you!
Ron Broughton,
LPC, CBIST · Chief Clinical Officer · Brookhaven Hospital
TBI and Identity Loss:
Recovering Self
Questions?
Ron Broughton,
MEd, LPC, CBIST · Chief Clinical Officer · Brookhaven Hospital